腹腔镜辅助经肛门拖出术（LATP）与完全经肛门拖出术（CTP）在先天性巨结肠症手术治疗中的比较

Laparoscopic-assisted transanal pull-through (LATP) versus complete transanal pull-through (CTP) in the surgical management of Hirschsprung's disease.

作者信息

Guerra Julia, Wayne Carolyn, Musambe Tatenda, Nasr Ahmed

机构信息

Department of Pediatric Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.

Department of Pediatric Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada.

出版信息

J Pediatr Surg. 2016 May;51(5):770-4. doi: 10.1016/j.jpedsurg.2016.02.020. Epub 2016 Feb 15.

DOI:10.1016/j.jpedsurg.2016.02.020

PMID:26949144

Abstract

BACKGROUND

It is unclear whether laparoscopic-assisted transanal pull-through (LATP) or complete transanal pull-through (CTP) is superior for the surgical management of Hirschsprung's disease. We compared outcomes between approaches.

METHODS

We retrospectively reviewed patients with Hirschsprung's disease who underwent LATP or CTP at our centre between 1995 and 2014. Patients were matched based on age, birth weight, and level of aganglionosis. A systematic literature review and meta-analysis were also performed.

RESULTS

From our data, LATP (n=24) took significantly longer than CTP (n=12; 3.9±1.1 vs. 2.6±0.6h, p=0.001). There was no difference in length of stay or incidence of postoperative complications. A literature search identified 17 published studies, of which 2 were comparative. Our pooled analysis of comparative studies including our results showed that operative time was significantly longer for the LATP group (OR 1.59, 95% CI 1.21-1.96, p<0.001). There was no significant difference in major complications (OR 1.75, 95% CI 0.76-4.04, p=0.19) or length of stay (OR 0.33, 95% CI -0.41 to 1.08, p=0.38).

CONCLUSION

Clinical outcomes are comparable between LATP and CTP. CTP offers shorter operative time without the need for laparoscopic instruments.

摘要

背景

对于先天性巨结肠症的手术治疗，腹腔镜辅助经肛门拖出术（LATP）或完全经肛门拖出术（CTP）哪种方法更具优势尚不清楚。我们比较了这两种手术方式的治疗效果。

方法

我们回顾性分析了1995年至2014年间在本中心接受LATP或CTP手术的先天性巨结肠症患者。根据年龄、出生体重和无神经节细胞症的范围对患者进行匹配。同时进行了系统的文献综述和荟萃分析。

结果

根据我们的数据，LATP组（n = 24）的手术时间明显长于CTP组（n = 12；3.9±1.1小时 vs. 2.6±0.6小时，p = 0.001）。住院时间和术后并发症发生率没有差异。文献检索共找到17项已发表的研究，其中2项为比较性研究。我们对包括本研究结果在内的比较性研究进行的汇总分析显示，LATP组的手术时间明显更长（OR 1.59，95%CI 1.21 - 1.96，p < 0.001）。主要并发症（OR 1.75，95%CI 0.76 - 4.04，p = 0.19）或住院时间（OR 0.33，95%CI -0.41至1.08，p = 0.38）没有显著差异。